ShearWorx knows our employees are crucial to our success. That’s why we provide an excellent benefits package that helps protect you and your family. The benefits package includes a variety of coverages, including medical, dental, vision, basic life, AD&D coverage, and more.
This enrollment guide will walk you through each of your benefit options for the coming plan year, as well as guide your enrollment process. It is very important to read the information provided in this enrollment guide and share it with your covered dependents.
All changes to benefit elections will be effective on October 1, 2025.
Additional policy information can be found in the Summary Plan Description (SPD) for each line of coverage or within the ‘Company Policy’ as described in your Employee Handbook. Also, if you have any questions about the enrollment process, please contact Human Resources or our benefits advisory team at Sterling Seacrest Pritchard.
*This Benefit Guide outlines health and welfare plans offered to you and your family. It contains general information and is meant to provide a brief overview. For complete details regarding each benefit plan offered, please refer to the individual plan documents, as the information contained herein is for illustrative purposes. More details can be found in the plan-specific Summary Plan Description(s) and Summary of Coverage. In the case of a discrepancy, the plan-specific documents will prevail.
Eligibility
Who is eligible to join the Benefits Plan?
You and your dependents are eligible to join the ShearWorx health and welfare benefit plan if you are a full-time employee. You must be enrolled in the plan to add dependent coverage.
Who is an eligible dependent?
• Your spouse to whom you are legally married
• Your dependent child under the maximum age specified in the Carriers’ plan documents, including a natural child, adopted child, stepchild, or child for whom you have been appointed as the legal guardian.
*Your child’s spouse or a child for whom you are not the legal guardian are not eligible.
The Dependent Maximum Age Limit is up to age 26. The dependent does not need to be a fulltime student; does not need to be an eligible dependent on the parent’s tax return; is not required to live with you; and may be married or unmarried. Once the dependent reaches age 26, coverage will terminate on the last day of the birth month.
A totally disabled child who is physically or mentally disabled prior to age 26 may remain on the plan if the child is primarily dependent on the enrolled member for support and maintenance.
Annual Open Enrollment
Each year during the annual Open Enrollment Period, you are given the opportunity to make changes to your current benefit elections.
During Open Enrollment, you may:
• Elect coverage
• Change any plan option
• Enroll eligible dependents
• Drop covered dependents
• Discontinue coverage
When do benefits become effective?
Your benefits become effective the first day of the month following the date of hire.
What are qualifying life events?
You are allowed to make changes to your current benefit elections during the plan year if you experience an IRS-approved qualifying life event. The change to your benefit elections must be consistent with and on account of the qualifying life event.
IRS-approved qualifying life events include:
• Marriage, divorce, or legal separation
• Death of a dependent
Please note loss of coverage due to nonpayment or voluntary termination of other coverage outside a spouse’s or parent’s enrollment is not an IRS-approved qualifying life event, and you do not qualify for a special enrollment period.
• Birth or adoption of a child or placement of a child for adoption
• Change in employment status, including loss or gain of employment, for your spouse, or dependent
• Change in work schedule, including switching between full-time and part-time status, by you, your spouse or a dependent
• Change in residence or work site for you, your spouse, or a dependent that results in a change of eligibility
• If you or your dependents lose eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) coverage
• If you or your dependents become eligible for a state’s premium assistance subsidy under Medicaid or CHIP
• Open Enrollment for a spouse or parent
If you have a life status change, you must notify Human Resources within 60 days for changes in life status due to a Medicare or CHIP event and within 31 days of the other events.
Enrollment
Enrolling with Employee Navigator
Step
2: Welcome!
Step 1: Log In
Go to www.employeenavigator.com and click Login.
Returning users: Log in with the username and password you selected. Click Reset a forgotten password.
First time users: Click “Register as a new user” and use your Name and information as appears on your W2 Payroll Documents and use Company ID: “SHWRX”.
After you login, click Let’s Begin to complete your enrollment and additional required tasks if applicable.
Step 4: Benefit Elections
Step 3: Start Enrollments
After clicking Start Enrollment, complete some personal & dependent information before moving to your benefit elections.
TIP: Have dependent details handy. To enroll, you will need their date of birth and Social Security number.
To enroll dependents in a benefit, click the check box next to the dependent’s name under Who am I enrolling?
Below your dependents you can view your available plans and the cost per pay. To elect a benefit, click Select Plan underneath the plan cost.
Click Save & Continue at the bottom of each screen to save your elections.
If you do not want a benefit, click Don’t want this benefit? At the bottom of the screen and select a reason from the drop-down menu.
Step 5: Forms
If you have elected benefits that require a beneficiary designation, Primary Care Physician, or completion of an Evidence of Insurability form, you will be prompted to add in those details.
Step 6: Review & Confirm Elections
Review the benefits you selected on the enrollment summary page to make sure they are correct then click Sign & Agree to complete your enrollment. You can either print a summary of your elections for your records or login at any point during the year to view your summary online.
TIP: If you miss a step you’ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted. Click on any incomplete steps to complete them.
Step 7:
You’re Finished
You are finished. You can go back to your homepage to view your elections and you can make changes until the enrollment window closes.
Cigna Health Plan Options So many ways to help manage your health.
Health care that’s there for you when and where you need it
Head-to-toe virtual care from MDLIVE.
Virtual care is making access to high-quality healthcare more convenient and affordable — for you and every covered member of your family. That s why Cigna Healthcare℠ has partnered with MDLIVE® to offer a broad suite of convenient virtual care options — available by phone or video, and in English or Spanish
Primary Care
Easy, fast appointments, referrals, prescriptions, lab work and diagnostic tests
Preventive care and wellness screenings available at no additional cost to identify conditions early.2
Manage chronic conditions and establish a relationship with the same primary care provider (PCP) through routine care.
• Receive orders for biometrics and blood work at local facilities.3
Urgent Care
On-demand 24/7 or schedule a time that works for you
• Convenient, affordable alternative to urgent care centers and the emergency room.
• Care for many minor illnesses and injuries, such as infections, cold & flu, and sinus problems.
• Includes pediatric care, allowing your child to be seen quickly and from the comfort of their home.
Prescriptions available through home delivery or at local pharmacies, if appropriate.
listed on next page.
It’s easy to connect to care.
1.
Access MDLIVE by logging into myCigna.com® or by using the myCigna® app.
2.
Find the “Talk to a Doctor” button on the homepage. You may have to scroll down.
Dermatology4
Fast, customized care for skin, hair, and nail conditions — no appointment required
Care for common skin, hair and nail conditions including acne, eczema, psoriasis, rosacea, suspicious spots and more.
Upload photos and describe symptoms for board-certified dermatologists to review.
• Diagnosis and customized treatment plan, usually within 24 hours.
Behavioral Care
Talk therapy and psychiatry from the privacy of home, with no waiting rooms
•Access to licensed therapists and boardcertified psychiatrists.
•Schedule an appointment that works for you and have recurring sessions with the same provider
•Care for topics such as anxiety stress, life changes, grief and depression.
3.
Select the type of virtual care you need — Medical or Counseling. Estimated cost will be shown.5
Virtual care visits are convenient and easy, whether you choose on-demand care or to schedule an appointment. And you can select an appointment in English or Spanish. Visit myCigna.com or call MDLIVE at 888.726.3171 when you need virtual care.
4.
Schedule your appointment or start your visit today.
will be referred to seek in-person care. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours.
5. Prices shown on myCigna are not a guarantee. Coverage falls under your plan terms and conditions.
Cigna Healthcare provides access to virtual care through national telehealth providers as part of your plan. This service is separate from your health plan’s network and may not be available in all areas or under all plans. Referrals are not required. Video may not be available in all areas or with all providers. Refer to plan documents for complete description of virtual care services and costs.
In California: Services may be available on an in-person basis or via telehealth from the enrollee’s primary care provider, treating specialist, or from another contracting individual health professional, contracting clinic, or contracting health facility consistent with California law. Enrollees that have coverage for out-of-network benefits may receive services either via telehealth or on an in-person basis using the enrollee’s out-of-network benefits. Note: out-of-network benefits, if available, will generally include higher out-of-pocket financial responsibility and no balance-billing protections. Please refer to your benefit plan documents for specific information about your benefit plan and out-of-network benefits.
Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company (Bloomfield, CT), Evernorth Care Solutions, Inc., Evernorth Behavioral Health, Inc., Express Scripts, Inc., or their affiliates. Policy forms: OK - HP-APP-1 et al., OR - HP-POL38 02-13, TN - HP-POL43/HC-CER1V1 et al. (CHLIC); GSA-COVER, et al. (CHC-TN).
1. Virtual primary care through MDLIVE is only available for Cigna Healthcare medical members aged 18 and older.
2. Appointments are required. For customers who have
The Cigna Healthcare well-being solution, together with Virgin Pulse.
Take a closer look at the features below — and discover how each one can drive engagement and help improve outcomes for your employees.
Make fills easier.
Home delivery with Express Scripts® Pharmacy is a convenient option when you’re taking a medication on a regular basis. It’s simple, safe – and saves you trips to the pharmacy.
Make fills easier. Have your medication sent to your home.
With just a few simple clicks of your mobile phone, tablet or computer, your important medications will be on their way to your door (or location of your choice).
• Easily order, manage, track and pay for your medications on your phone or online
• Standard shipping at no extra cost2
• Fill up to a 90-day supply at one time3
• Helpful pharmacists available 24/7
Automatic refills4 or refill reminders so you don’t miss a dose
• Flexible payment options – split your bill into three smaller equal payments
Three easy ways to get started using Express Scripts® Pharmacy
1. Log in to the myCigna® App5 or myCigna.com® to move your prescription electronically. Click on the Prescriptions tab and select My Medications from the dropdown menu. Then simply click the button next to your medication name to move your prescription(s). Or,
2. Call your doctor’s office. Ask them to send a 90-day prescription (with refills) electronically to Express Scripts Home Delivery. Or,
3. Call Express Scripts® Pharmacy at 800.835.3784 They’ll contact your doctor’s office to get your prescription. Have your Cigna HealthcareSM ID card, doctor’s contact information and medication name(s) ready when you call.
Got a new prescription?
Ask your doctor to send it to Express Scripts® Pharmacy for you.
1. Electronically: For fastest service, have them send it electronically to Express Scripts® Home Delivery, NCPDP 2623735. Or,
2. By fax: Have them call 888.327.9791 to get a Fax Order Form.
HSA Overview
What is an HSA?
An HSA is a tax-advantaged personal savings account that can be used to pay for medical, dental, vision, and other qualified expenses now or later in life. To contribute to an HSA you must be enrolled in a qualified highdeductible health plan (HDHP) and your contributions are limited annually. The funds can even be invested, making it a great addition to your retirement portfolio. HSA accounts can be created through Pinnacle Financial.
What expenses are eligible for reimbursement?
Health plan co-pays, deductibles, co-insurance, vision, dental care, and certain medical supplies are covered. The IRS provides specific guidance regarding eligible expenses. (See IRS Publication 502).
Am
I eligible to participate?
In order to contribute, you must be enrolled in a qualified HDHP, not covered under a secondary health insurance plan, not enrolled in Medicare, and not another person’s dependent. There are no eligibility requirements to spend previously-contributed HSA funds.
How do I contribute to my HSA?
Payroll deduction is most likely offered by your employer. Your annual contribution will be divided into equal amounts and deducted from your payroll before taxes. Direct contributions can also be made from your personal checking account and can be deducted on your personal tax return.
How much can I contribute to my HSA?
The HSA contribution limits for 2025 are $4,300 for self-only coverage and $8,550 for family coverage. Those 55 and older can contribute an additional $1,000 as a catch-up contribution. The HSA contribution limits for 2026 are $4,400 for self-only coverage and $8,750 for family coverage. Those 55 and older can contribute an additional $1,000 as a catch-up contribution.
Flexible Spending Accounts
Flexible Spending Account Overview
A flexible spending account (FSA) is an account in an employee’s name that reimburses the employee for qualified health care or dependent care expenses. It allows an employee to fund qualified expenses with pre-tax dollars deducted from the employee’s paychecks. The employee can receive cash reimbursement up to the total value of the account for covered expenses incurred during the benefit plan year and any applicable grace period.
Frequently Asked Questions About your FSA
What is a Flexible Spending Account (FSA)?
An FSA is an employer-sponsored plan that allows you to deduct dollars from your paycheck and deposit them into a special account that’s protected from taxes. FSA accounts are exempt from federal taxes, Social Security (FICA) taxes and, in most cases, state income taxes. The money in an FSA can be used for eligible health and/or dependent care expenses that are incurred while you are participating in the plan.
When does my FSA become effective?
Your FSA becomes effective on January 1st of the new year after Open Enrollment. The New Hire Waiting period is First of the Month following 90 days.
How do I participate in an FSA?
To participate, you must enroll within 30 days of your date of hire, or elect to participate during annual Open Enrollment. If you have a life event change (for example, marriage, birth or adoption of a child), then you can elect coverage within 30 days of the change.
Who qualifies as an eligible dependent for the Dependent Care FSA?
An eligible dependent is any dependent for which an employee pays a provider to care for him/her while they are at work or looking for work. The dependent must be under the age of 13 or incapable of taking care of themselves, and live in the employee’s home for more than half of the year.
How often can I request reimbursements from the Dependent Care FSA?
Reimbursements can be requested as often as qualified expenses are incurred. Expenses must be incurred during the calendar year and the reimbursement must be requested before the end of the run-out period.
What happens if I have money remaining in my account at the end of the year?
You are able to rollover up to the IRS Maximum of $640 at the end of the year with the Health FSA. Any funds over the rollover maximum will be forfeited. The Dependent Care FSA is considered as a “use it or lose it” account. Any funds remaining in the account at the end of the year will be forfeited. You will have 90 days at the end of the calendar year to file for reimbursements of expenses incurred during the year.
Can I change my election or stop contributing money to my FSA at any time during the plan year?
Federal regulations state that once you have enrolled in an FSA, you cannot change your election amount unless you have a qualifying life event.
What type of flexible spending plans are there?
Health Care FSA: Covers medical, prescription, dental and vision expenses
Dependent Care FSA Covers dependent care expenses including daycare, nursery school and day camp for children, and services for adult dependents who cannot care for themselves
Limited Health Care FSA: Covers dental and vision expenses only (for compliance with a health savings account)
FSA Mobile App
How does it work?
Designed so consumers can quickly find what they need most, our app provides easy, on-the-go access to all their health and benefit accounts.
Consumers can:
• See all accounts in one place
• Log in with User ID and password or face recognition
• Check balances and account details
• View HSA investment performance and rebalance funds
• Upload documentation, receipts and claims using the phone’s camera
• Scan barcodes for expense eligibility
• Use Smart Scan to upload Explanation of Benefits (EOB)
• Set text message alerts for account activity and added security
FSA Debit Card
Payment Options
Employees have access to their HSA and FSA funds through a debit card that can be used at any qualified provider or merchant that offers health products or services or dependent care.
In addition, employees can request direct payment to a provider or individual as a one-time or recurring expense using the consumer portal or mobile app. Pinnacle will send a check or ACH payment directly to the provider at no cost.
Employees may also reimburse themselves by linking a personal checking or savings account from any financial institution to their benefit account and receive a direct deposit, also at no cost.
Vertical and Versatile Debit Card
• One-card solution includes all account types on a single card
• Additional cards available at no cost
• Can be used at any merchant or provider that offers qualified products or services
• EMV chipped smart cards for added security
Dental Benefits
Good dental care is critical to your overall well-being. With Cigna Dental insurance, you can get the attention your teeth need — at a cost you can afford. Cigna Dental allows you to see any dentist you choose. To get the most from your benefits and reduce out-of-pocket costs, choose an in-network provider by utilizing our large national network. These providers have agreed to file your claims and uphold the highest quality standards. You can find in-network providers at mycigna.com.
Vision Benefits
Cigna Vision, Powered by EyeMed
Members have the freedom to choose any provider from EyeMed’s Insight Network. Our network offers the right mix of independent, national retail and regional retail providers like Lens Crafters, Pearle Vision, Target Optical and many more. Members can also purchase glasses and contact lenses online at Glasses.com and ContactsDirect.com.
Covered Benefits
Basic Term Life with AD&D Benefits
Employer-Paid Basic Term Life with AD&D
You keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more. AD&D Insurance is also available, which can pay a benefit if you survive an accident but have certain serious injuries. It can pay an additional amount if you die from a covered accident. Your employer is offering this coverage at no cost to you. The Basic Life and AD&D benefit is $25,000.
Voluntary Life and AD&D Benefits
Voluntary Life with AD&D
You choose the amount of coverage that’s right for you, and you keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more. AD&D Insurance is also available, which pays a benefit if you survive an accident but have certain serious injuries. It pays an additional amount if you die from a covered accident.
Who can get Term Life coverage?
If you are actively at work at least 30 hours per week, you may apply for coverage for:
You: Choose from $10,000 to $500,000 in $10,000 increments, up to 5 times your earnings. You can get up to $100,000. This is the amount of coverage you can qualify for with no medical underwriting.
Your Spouse: Get up to $500,000 of coverage in $5,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself. Your spouse can get up to $25,000 with no medical underwriting, if eligible (see delayed effective date).
Your children: Get up to $10,000 of coverage in $2,000 increments if eligible (see delayed effective date). One policy covers all of your children until their 19th birthday - or until their 26th birthday if they are full-time students. The maximum benefit for children live birth to 6 months is $1,000.
Voluntary Short Term Disability
How does it work?
Short Term Disability Insurance pays you a weekly benefit if you have a covered disability that keeps you from working. If a covered illness or injury keeps you from working, Short Term Disability Insurance replaces part of your income while you recover. As long as you remain disabled, you can receive 60% of your weekly income, up to a maximum benefit of $750 per week, for up to 24 weeks. The weekly benefit may be reduced or offset by other sources of income. You’re generally considered disabled if you’re unable to do important parts of your job — and your income suffers as a result. You can use the money however you choose. It can help you pay for your rent or mortgage, groceries, out-of-pocket medical expenses and more.
What else is included?
Cesarean section benefit: If you have a Cesarean section, you will be considered disabled for a minimum period of eight weeks unless you return to work before the end of the time.
Short Term Disability Rates
Long Term Disability Insurance
How does it work?
Long Term Disability Insurance can replace part of your income if a disability keeps you out of work for a long period of time. This coverage provides a monthly benefit if you have a covered illness or injury and you can’t work for a few months — or even longer. You’re generally considered disabled if you’re unable to do important parts of your job — and your income suffers as a result.
You can use the money however you choose. It can help you pay for your rent or mortgage, groceries, out-of-pocket medical expenses and more.
The Long Term Disability benefit covers 60% of your monthly income, up to a maximum payment of $5,000. The monthly benefit may be reduced or offset by other sources of income.
Group Accident Insurance
How does it work?
Accident Insurance provides a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job. And it includes a range of incidents, from common injuries to more serious events. It can help you with out-of-pocket costs that your medical plan doesn’t cover, like copays and deductibles. You’ll have base coverage without medical underwriting. The cost is conveniently deducted from your paycheck. You can keep your coverage if you change jobs or retire. You’ll be billed directly.
Be Well Benefit
Every year, each family member who has Accident coverage can also receive $50 for getting a covered Be Well screening test.
Who can get coverage?
You: If you’re actively at work*
Your spouse: Can get coverage as long as you have purchased coverage for yourself.
Your children: Dependent children from birth until their 26th birthday, regardless of marital or student status.
Group Critical Illness Insurance
How does it work?
If you’re diagnosed with an illness that is covered by this insurance, you can receive a lump sum benefit payment. You can use the money however you want. You can use this coverage more than once. Even after you receive a payout for one illness, you’re still covered for the remaining conditions and for the reoccurrence of any critical illness with the exception of skin cancer. The reoccurrence benefit can pay 100% of your coverage amount. Diagnoses must be at least 180 days apart or the conditions can’t be related to each other.
Who can get coverage?
You: Choose $10,000, $20,000 or $30,000 of coverage with no medical underwriting to qualify if you apply during this enrollment.
Your spouse: Spouses can only get 50% of the employee coverage amount as long as you have purchased coverage for yourself.
Your children: Children from live birth to age 26 are automatically covered at no extra cost. Their coverage amount is 50% of yours. They are covered for all the same illnesses plus these specific childhood conditions: cerebral palsy, cleft lip or palate, cystic fibrosis, Down syndrome and spina bifida. The diagnosis must occur after the child’s coverage effective date.
Be Well Benefit
Every year, each family member who has Critical Illness coverage can also receive a payment for getting a covered Be Well Benefit screening test.
Group Critical Illness Insurance
Financial Wellness & Identity Protection
Experian Elite Plan
Get help achieving financial wellness sooner with unique insights Our Elite benefits plan features Digital Financial Manager—providing you tools to help manage your finances and credit profile in a single experience. Employee Navigator will show you your personalized rates and options.
• Identity & Device Protection & Restoration Services that include tri-bureau credit monitoring, dark web monitoring, child monitoring, device protection, identity restoration services, $1M reimbursement insurance, and more!
• Variety of financial tools such as automated budgeting, cash flow & debt management, net worth tracking, and financial goal planning.
• Financial and credit insights and recommendations to help you achieve your credit and financial goals.
$12.07 $6.71
$16.50 $8.92
$29.45 $15.40
$39.84 $20.59 70-74 $53.89 $27.62
$71.47 $36.41
$93.63 $47.49
$138.42 $69.88
• Access to a suite of device protection tools to help you keep your passwords and other personal information secure while surfing the web.
Legal Notices
THIS GUIDE
This brochure summarizes the health care and income protection benefits that are available to Shearworx employees and their eligible dependents. Official plan documents, policies, and certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits. These documents govern your benefits program. If there is any conflict, the official documents prevail. These documents are available upon request through your Human Resources department. Information provided in this brochure is not a guarantee of benefits.
SPECIAL ENROLLMENT NOTICES
If you decline enrollment in your employer’s health plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in your employer’s plan without waiting for the next open enrollment period if you:
• Lose other health insurance or group health plan coverage. You must request enrollment within 30 days after the loss of other coverage.
• Gain a new dependent as a result of marriage, birth, adoption or placement for adoption. You must request (medical plan OR health plan) enrollment within 30 days after the marriage, birth, adoption or placement for adoption.
• Lose Medicaid, or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible. You must request medical plan enrollment within 60 days after the loss of such coverage.
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
Shearworx, in accordance with HIPAA, protects your Protected Health Information (PHI). We will only discuss your PHI with medical providers and third party administrators when necessary to administer the plan that provides you your medical, dental and vision benefits or as mandated by law. A copy of the Notice of Privacy is available upon request through your Human Resources department.
WOMEN’S HEALTH ACT
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:
• All stages of reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance;
• Prostheses; and
• Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you have any questions about your coverage please contact your Human Resources department.
CONTINUATION REQUIRED BY FEDERAL LAW FOR YOU & YOUR DEPENDENTS (COBRA)
The continuation required by Federal Law does not apply to any benefits for loss of life, dismemberment or loss of income. Federal law enables you or your dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than gross misconduct). Federal law also enables your dependents to continue health insurance if their coverage ceases due to your health, divorce, or legal separation, or with respect to a dependent child, failure to continue to qualify as a dependent. Continuation must be elected in accordance with the rules of your Employer’s group health plan(s) and is subject to federal law, regulations and interpretations.
MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid of CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or visit www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the state if it has a program that might help you pay the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the health plan - as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity and you must request coverage within 60 days of being determined eligible for premium assistance. The full CHIP Notice is available upon request from your Human Resources department.
NEWBORNS’ & MOTHERS’ HEALTH PROTECTION ACT
Federal law prohibits the plan from limiting a mother’s or newborn’s length of hospital stay to less than 48 hours for a normal delivery or 96 hours for a Cesarean delivery or from requiring the provider to obtain pre-authorization for a stay of 48 or 96 hours, as appropriate. However, federal law generally does not prohibit the attending provider, after consultation with the mother, from discharging the mother or her newborn earlier than 48 hours for normal delivery or 96 hours for Cesarean delivery.
